PCD Introduction for Physicians

1. PCD PARTNERS introduction TO PHYSICIANS

2. Who is PCD Partners? PCD Partners is comprised of world class physicians, academics, and entrepreneurs who have decades of experience with collaboration in medical quality and practice improvement systems for large scale practice management and clinical practice improvement. The founders and principals of PCD Partners have devoted their careers to establishing themselves as leaders in the healthcare field as physicians, academics, senior administrators, entrepreneurs, and lawyers. Their collective wisdom and experience is a critical component of every PCD Partners offering. PCD Partners was formed to bring together the combined experience and intellect of our principals to apply towards solving many of the challenges that physicians and hospitals are facing. Our partners are committed to playing an active role in improving the efficiency, quality and consistency of healthcare delivery. We have the clinical, administrative, quality, and systems acumen to help any healthcare delivery system. Align Measure Improve 2

4. Data Process & Capture,

5. Governance,

6. Complex System Integration and Implementation;

7. Deep And Broad Clinical Expertise And Experience

8. Extensive Vascular, Cardiology and Orthopedic,

9. Operation “Reboot”,

10. Risk Adjusted Outcomes;

11. Thoroughly Trained In Quality Standards And Process Redesign

12. Lean Six Sigma in Clinical Healthcare Applications,

13. ISO 9001 Quality System,

14. System-wide Quality Initiatives,

15. Process Redesign And Optimization.Align Measure Improve 3

17. Measurethe right quality and efficiency variables, ensure excellent data governance and buy-in, and make the data transparent to stakeholders

19. Measure What is it? To be useful, the right data needs to be in the right format in the right place at the right time. Data is required to be able to measure anything in a meaningful way; without data there is no knowledge. CMAs require that quality and efficiency performance objectives and metrics, data management, training and operations plans, and valuation must be defined. Incentive bonuses are earned by producing data to demonstrate measurable quality improvements over specified time periods. How does a CMA help with Alignment? PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and provide an independent 3rd party Valuation Fairness Opinion. Our real time dashboards will help you to transform data into knowledge that is meaningful for all parties. How can PCD add value? Having the right data available and in a useful format is the key to optimizing quality across a healthcare delivery system. The majority of data required to produce an effective system wide quality system comes from outside of the EMR. In order to effectively identify, collect and transform all of the data required into useful knowledge requires experience skill and the right tools. What are the implications for a system wide quality initiative?

20. Improve What is it? Improvement can come in many forms: increased throughput, reduced costs, reduced defects, improved efficiency and most importantly, improved patient outcomes. Realization of these improvements is the result analyzing and optimizing processes using best practice methodologies. CMA quality incentive bonuses are structured to provide an incentive payment that is commensurate with measurable and demonstrable improvements that can be proven through the data in the quality system. How does a CMA help with Alignment? PCD’s clinical skills, operational know-how and data expertise will combine to develop the process improvements that ensure that you achieve optimal results. PCD’s consultants are Lean Six Sigma and ISO 9001 trained to identify and reduce waste, reduce defects and develop processes and procedures that are tracked by an exception and corrective action tracking tool to ensure compliance and visibility to quality performance. How can PCD add value? Having the right alignment structure and measurement capabilities are pre-requisitesto realizing meaningful improvement, but do not assure improvement on their own. The addition of Lean Six Sigma principles does not guarantee process improvements without the role definition, process standardization and reporting infrastructure that ISO 9001 compliance assures. What are the implications for a system wide quality initiative?

21. When Should a Physician Consider a CMA? When your group or practice is considering integration alternatives with the hospitals that you practice in. When you are feeling pressure to evaluate the economic security of hospital employment despite your desire to remain independent. When you are seeking additional sources of revenue to replace reduced reimbursements and changing incentives under new payment models. When you are looking to collaborate with your hospital to promote evidence-based medicine, coordination of care, outcome measurement and reporting, operational efficiencies and other organizational improvement efforts. When you want a stepping stone to serve as a template for an accountable care organization (“ACO”) or as the foundation for a bundled payment arrangement without resorting to hospital employment or selling your practice. 8 Align Measure Improve

22. Why a CMA Versus Other Structures? Clinical (or service-line) Co-Management Arrangements (CMA) are one of the most successful strategies that hospitals and physicians are using to achieve clinical integration, strategic alignment and collaboration. A CMA allows the physicians to share in the hospital’s service line revenue in addition to their own professional fees in exchange for providing operational oversight of the service line. The CMA is an effective structure for creating collaboration between physicians and the hospitals where they practice. It is the only structure that provides on-going financial rewards; it is also the only structure that requires the use of data to improve quality, and it can co-exist with any other alignment structure. A CMA provides the structure for the physicians and the hospital to work together to leverage the work done in a co-management arrangement to succeed under new payment models and to position the physicians and hospital with ACOs that are looking for efficient partners. 9 Align Measure Improve

23. How Do CMA Financial Incentives Work? The Co-Management Arrangement (CMA) will specify additional administrative and bonus compensation to be paid by the hospital to the physicians to provide incentives for the physicians to take responsibility for improving metrics related to quality, efficiency, and budget in a hospital service line. CMAs are a vehicle which permit the physicians to share in the hospital revenue for a specific service line without violating Stark, anti-kickback or other regulations. Physicians earn financial bonuses for improvements in a service line’s operational, clinical and budgetary performance. The co-management model rewards physician leadership during significant and rapid change and can be used to empower physicians to be the architects in redesigning the healthcare delivery model. 10 Align Measure Improve

24. What is the Result of a Properly Implemented CMA? Patients get the benefit from a system that is working closely together to achieve a common set of objectives. A common plan and vision that was created jointly by the physicians and the hospital; Financial incentives for physicians for measuring and improving quality and efficiency; Physicians having greater impact on achieving operational and process improvements; Joint implementation of quality and safety standards by the physicians and the hospital; 11

25. What Are PCD Partners’ Deliverables? PCD can help define quality and efficiency performance objectives and metrics, structure a data management plan, develop and deliver training and operations plans, and act as an independent 3rd party to the arrangement. Our real time dashboards will help to transform data into knowledge that is meaningful for all parties. PCD can help to maximize the incentive bonuses by leveraging our experience in gathering meaningful clinical data and transforming it into knowledge to improve patient outcomes. PCD has the clinical skills, operational know-how and the data expertise to help to develop the process improvements that ensure the realization of measurable and meaningful results. PCD’s consultants are trained in Lean Six Sigma and ISO 9001 to identify and reduce waste, reduce defects and develop processes and procedures that are reinforced by a variance reporting and corrective action tracking tool to ensure compliance and visibility to quality improvements. 12 Align Measure Improve

26. PCD Partners Value Add Considerations 13

27. World Class Partners CHARLES HUTCHINSON, PhD Chairman Co-founder and CEO, GlycoFi, Inc. (acquired by Merck in 2006), Founder, M2S, Inc. and SustainX, Inc., Dean Emeritus, Thayer School of Engineering at Dartmouth, Ph.D., Stanford M. WESTON CHAPMAN CEO Chairman, President & CEO, M2S (acquired by AIG affiliate), Managing Director, Oppenheimer & Co. and Donaldson, Lufkin & Jenrette, Adjunct Professor, ISO medical quality systems, Dartmouth Medical School, A.B. Dartmouth, M.B.A. Tuck GRANT BAGLEY, MD, JD Partner Past Managing Partner, Healthcare Practice, Arnold & Porter, Past Director, Coverage and Analysis, Centers for Medicare & Medicaid Services DONALD S BIALEK MD MPH Partner Managing Director, Huron Consulting Group; SME, CSC Global Health Services; Physician Executive, Dearborn Advisors; CEO, Alliance Medical Practices; CEO, Paradigm Medical Teams; Faculty, Harvard University; NLM Informatics Fellow, Harvard/MIT; BSc, Univ of MD; MD, Univ of MN; MPH, Harvard University COLIN C. BLAYDON, AM, PHD Partner Director, Center for Private Equity & Entrepreneurship Dean Emeritus, Tuck School of Business at Dartmouth Professor, Harvard Business School Dept. Of Defense, OMB BEE Univ. of Virginia, AM Harvard, PhD Harvard 14

28. World Class Partners MICHAEL A. CHOUKAS Partner President and CEO, Oncopartners, EVP United Biosource Corp., Chairman & CEO, Scirex Corp., Chairman & CEO Springborn Laboratories (Now STRI,NYSE),Partner, Bain & Company, Legislative Director, US Senator Patrick Leahy, B.A. Dartmouth, M.B.A. Harvard Business School JOHN C. COLLINS, MPH, JD Partner Chair and President, Hampden Assurance Co. Ltd., Chief Executive Officer, Dartmouth-Hitchcock Clinic, Dartmouth-Hitchcock Medical Center Director BCBS of Vermont Assist. Prof. Dartmouth Medical School BS Cornell, MPH Michigan, JD Georgetown JACK CRONENWETT, MD Partner, Chief Medical Officer Chair Emeritus, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center Medical Director, Vascular Study Group of New England, Professor of Surgery, Dartmouth-Hitchcock Medical Center, B.S. Michigan, M.D. Stanford ADAM GROFF, MD, MBA Partner Division Director, Bayada Nurses, Inc., Hospitalist, Dartmouth-Hitchcock Medical Center, Assistant Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, A.B. Dartmouth, M.D. Penn, M.B.A. Wharton MARK ISRAEL, MD Partner, Chairman of the Medical Advisory Board Director, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Professor, Pediatrics and Genetics, Dartmouth Medical School, B.A. Hamilton, M.D. Albert Einstein 15

29. World Class Partners DR. GERRY O’CONNOR, PhDConsultant, Design and Implementation of Clinical Quality Programs, Principal Investigator, National Quality Program, Cystic Fibrosis Foundation Partner, Quality Program Director Research Director, Northern New England Cardiovascular Disease Study Group, Corporate, Professor, Dartmouth Medical School and The Dartmouth Institute for Health Policy & Clinical Practice, B.S. Columbia, Ph.D. Union, Sc.D. BU, M.P.A Harvard Staff PAUL CARREIRO, PA Corporate Consultant Medical Staff Officer, U.S. Merchant Marine Consultant, New England Center for Emergency Preparedness, Dartmouth Medical School Board of Advisors, Franklin Pierce University Physician Assistant Program A.B. Harvard, B.S. University of Texas, JFK Special Warfare Center for Low Intensity Conflict, Flight Surgeon - School of Aviation Medicine, U.S. Army VEKRAM JENARTHANAN Project Manager Vekram has previously worked in the fields of data analytics and information management in the banking and insurance verticals. His experiences and interests in project management and TQM make him an ideal fit for PCD. His work at PCD involves the technical design and implementation of quality management systems. B.E. (Electrical and Electronics Engineering) College of Engineering Guindy - Chennai, India M.E.M. Duke University JON LEET Director of Sales & Marketing Jon brings 25+ years of sales and marketing accomplishments with both large companies (Oracle, IBM) and startup companies across a variety of technologies and industry verticals. Jon is responsible for working with PCD management to implement a structured sales process and develop a focused marketing plan. B.A. Colorado College. 16